You are here

Northamptonshire Substance to Solution (STS) Good

Inspection Summary


Overall summary & rating

Good

Updated 30 August 2019

  • The provider had robust health and safety processes in place to provide clients with community-based substance misuse services. Clients received a comprehensive assessment in a timely manner which included a physical health assessment.
  • Clients had robust risk management plans in place which staff reviewed every three months or more frequently where required. Staff were able to identify signs of deteriorating mental health.
  • All locality hubs had a range of appropriate rooms to meet clients. The clinical rooms were clean, well-stocked and regularly reviewed by the clinical lead nurse. Staff had access to Naloxone (Naloxone is used to reverse the effects of opioids).
  • The provider had robust policies, procedures and training related to medication and medicines management. These included: prescribing, detoxification and assessing client’s tolerance to medication. Staff adhered to infection control principles, including handwashing and the disposal and storage of clinical waste.
  • There was enough staff at all grades, with the right skills and experience to meet the needs of the clients. Staff had received mandatory training and received training relevant for their role.
  • The service had a robust process for the recording, investigation and learning from incidents. There was evidence of learning from incidents that had been embedded in practice.
  • There were robust governance systems in place to effectively manage the service. Managers had the right skills and experience to provide leadership and had good oversight of the service. Performance was monitored, and the outcomes were recorded on key performance indicator dashboards. This meant the manager could monitor performance over a period to ensure continuous improvement. Managers communicated the results to staff.

However:

  • There was no glucometer (to test client’s blood glucose) in Wellingborough.
  • Not all complaints had been acknowledged within the providers agreed time frame of five working days.
Inspection areas

Safe

Good

Updated 30 August 2019

We rated safe as good because:

  • The service had a range of skilled and trained professionals to deliver safe care and detoxification treatment.

  • The service had robust health and safety systems in place to manage the safety of clients and staff across all four hubs. Managers had completed ligature risk assessments, and staff were aware of how to minimise risks.

  • Specialist substance misuse community service facilities were well-designed, visibly clean and meet the needs of the client group

  • All hubs had a range of appropriate rooms to meet clients for group meetings, one to one appointments, medical reviews and for needle exchange.

  • Staff managed the prescribing of medications well. Staff were trained in the administration of Naloxone and had access to this at each hub.

  • Managers ensured that there was enough staff at all grades to meet the needs of the clients. The registered manager planned for staffing shortages by arranging staff moves across the four hubs, booking agency staff and distributing work load amongst the team. Staff received mandatory training suitable for their role and had access to a wide range of learning relating to their job role.

  • We reviewed 28 care and treatment records. Staff had completed a risk management plan during the first assessment. Staff reviewed these regularly as a minimum three monthly, or as and when needed.

  • Risk management plans were discussed upon first assessment and regularly reviewed at service user plan reviews and three-monthly full risk reviews, or more frequently where required.

  • There is a clear safeguarding policy and identified safeguarding lead and doctor. Staff had received safeguarding training. The provider had robust policies, procedures & training related to medication and medicines management which included: prescribing, detoxification, assessing people’s tolerance to medication and harm minimisation.

  • The service had a robust process for the recording, investigation and learning from incidents.

However:

  • There was no glucometer in Wellingborough. A glucometer measures how much glucose is in the blood.

Effective

Good

Updated 30 August 2019

We rated effective as good because:

  • Staff had competed comprehensive assessment for all clients in a timely manner. This included a physical health assessment. Staff used a range of clinical outcome measures to inform client assessment and progress. Staff delivered care and treatment options in line with best practice including guidance from the National Institute for Health and Care Excellence and National Treatment Agency.

  • Staff together with clients had completed recovery focused care plans, which addressed the needs of clients. Client recovery plans included risk management plans.

  • Staff supported clients to minimise risks associated with substance misuse. Blood borne virus testing and testing for sexually transmitted diseases were offered where appropriate. The service had a focus on wellbeing and supported clients to lead healthier lives.

  • Staff had the knowledge, skills and competencies for their roles. All staff received a comprehensive induction. The service offered a wide range of training opportunities alongside mandatory training.

  • Staff assessed client’s capacity and competence, which was recorded and managed well.

  • The multidisciplinary team met daily to discuss service user progress and needs. Staff ensured that there was multidisciplinary input into client's care including access to other services where required.

  • At the time of the inspection the provider had made changes to the appraisal system following feedback from staff. The new system was in the process of being implemented and there were plans in place to ensure all staff received the new format appraisals.

    However

  • Staff were not always documenting when care reviews took place, within the care plans.

Caring

Good

Updated 30 August 2019

We rated caring as good because:

  • Staff treated clients with kindness and compassion. We observed when interacting with clients, staff demonstrated compassion, dignity and respect.

  • Staff told us that they felt supported by the organisation. Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes to clients without fear of the consequences.

  • Staff supported clients to understand and manage their care, treatment or condition. This included education regarding harm minimisation.

  • Staff enabled families and carers to give feedback on the service they received. For example, via surveys or community meetings. Feedback reviewed was generally positive.

However:

  • Care records did not always show that clients had been given a copy of their care plan.

Responsive

Good

Updated 30 August 2019

We rated responsive as good because:

  • The provider had a clear documented acceptance and referral criteria in place. This had been agreed with relevant services and key stakeholders which all staff were aware off. This included allocated beds for detoxification and rehabilitation.

  • The provider was able to see clients quickly. Staff accepted referrals via the single point of access service and clients could access services via the drop-in clinics.

  • Staff completed recovery and risk management plans, which reflected the diverse and individual needs of the clients. These included clear care pathways to other supporting services. For example, maternity, social and housing services. Staff supported clients during referrals to transfer to other services.

  • The providers had a robust complaint process in place. Clients spoken with told us they knew how to complain and felt like staff would support them if they wished to raise a complaint.

  • Staff planned for clients’ discharge, including good liaison with a range of other agencies.

However

  • Two of the five complaints we reviewed had not been acknowledged by staff in line with their policy, within five working days of receipt.

Well-led

Good

Updated 30 August 2019

We rated well-led as good because:

  • Mangers provided clinical leadership and had a good understanding of the services they managed. Most staff told us that managers were visible, and staff found them approachable.

  • Staff were aware of the provider’s vision and values and had been involved in the reviewing of these. Staff understood their job roles and were able to explain how they were working to ensure high standards of care.

  • Staff informed us that the culture of the organisation had greatly improved over the past 18 months. Most staff told us that they felt valued and respected and described managers as visible and approachable.

  • The provider had policies procedures and protocols in place which staff had access to. There was an open culture to learning. Staff had made changes following learning from incidents and complaints.

  • The provider had robust systems in place to assess and manage client and organisation risks. Staff had the ability to submit items to the provider risk register.

Checks on specific services

Community-based substance misuse services

Good

Updated 30 August 2019